Provider Demographics
NPI:1447500806
Name:CHRISTENSEN, RANDALL MARK (MS)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:MARK
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6798
Mailing Address - Country:US
Mailing Address - Phone:989-573-0787
Mailing Address - Fax:
Practice Address - Street 1:6195 MILLER RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1599
Practice Address - Country:US
Practice Address - Phone:810-630-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007038103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling